Infliximab drug and infusion costs among patients with Crohn's disease in a commercially-insured setting.

Significant attention has been paid to the cost of treating patients with anti-TNF agents for diseases including Crohn's disease (CD). To evaluate the actual expenditures for infliximab in routine clinical practice, the authors examined patterns of administration and reimbursement among commercially-insured patients receiving infliximab for CD. Integrated pharmacy and medical claims data were obtained from 78 US health plans. Data from CD patients treated with infliximab between June 2000 and December 2003 were analyzed. Each claim for an infusion (HCPCS code J1745) represented a single observation. Descriptive statistics were generated for the number of vials billed for each infusion, total charged amount (ie, the amount submitted by providers), and total paid amount (ie, the amount reimbursed by the health plan, net of any patient copayment, coinsurance, or deductible). A total of 2230 CD patients were identified; of the original total of 9724 infusions, 168 were not evaluable because of data quality issues, yielding cost evaluation for 9556 total infusions. At each infusion, claims for a mean (SD) of 4.79 (1.74) vials were submitted (median = 5). Corresponding charged amounts were 4441 dollars (1778 dollars) (median = 4099 dollars); paid amounts averaged 2793 dollars (990 dollars) (median = 2628 dollars). Charged and paid amounts per vial billed averaged 927 dollars and 583 dollars, respectively. The average cost of administering a dose of infliximab to a commercial insurer is approximately 2800 dollars. Assumptions regarding infusion costs for infliximab based on charged amounts may be misleading; the true costs of administering infliximab in routine practice are likely to be lower than that reported for charged amounts.